Cochrane review finds chemoradiotherapy improved survival in women with cervical cancer

Chemoradiotherapy demonstrated improved outcomes in women with cervical cancer, according to a review conducted by the Cochrane Collaboration researchers. Chemoradiotherapy treatment was beneficial whether it involved platinum-based or non-platinum-based chemotherapy drugs.

In 1999, the National Cancer Institute issued a clinical alert recommending chemoradiotherapy as an alternate treatment to radiotherapy alone in women with cervical cancer; however, two subsequent reviews found that some important clinical questions were unanswered.

To assess the efficacy of chemoradiotherapy, Cochrane researchers conducted a meta-analysis and examined data from 15 studies involving 3,452 women.

In analysis of 13 trials comparing chemoradiotherapy vs. radiotherapy, a 6% improvement was observed for five-year survival in the chemoradiotherapy group (HR=0.81; 95% CI, 0.71-0.91). Also, survival benefit was greater for two trials in which chemotherapy was given after chemoradiotherapy, according to researchers.

Survival benefit was demonstrated for those treated with both platinum-based (HR=0.83; 95% CI, 0.71-0.97) and non-platinum-based (HR=0.77; 95% CI, 0.63-0.94) chemoradiotherapy.

Local and distant recurrence and progression decreased with chemoradiotherapy, and DFS was improved. Hematological and gastrointestinal toxicity were elevated with chemoradiotherapy; however, data were too sparse for late toxicity analysis.

“These results endorse the recommendations of the NCI alert, but also demonstrate their applicability to all women and a benefit of non-platinum-based chemoradiotherapy,” the researchers wrote. “Furthermore, although these results suggest an additional benefit from adjuvant chemotherapy, this requires testing in randomized controlled trials.”

Cochrane Database of Systematic Reviews 2010. 2010;doi:10.1002/14651858.CD008285.